Giáo trình fundamental of case management practice skills for human servies 5e by summers

Fifth edition

Fundamentals of

Case
Management
Practice
Skills for the Human Services
Nancy Summers
Harrisburg Area Community College

Australia • Brazil • Mexico • Singapore • United Kingdom • United States

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Fundamentals of Case Management
Practice: Skills for the Human Services,

Fifth edition
Nancy Summers
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To my parents, whose humor and wisdom about people and relationships formed the
foundation for my work with others

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Contents

Preface  xiii

Section 1 F
 oundations for Best Practice
in Case Management
Chapter 1
Case Management: Definition and Responsibilities   1
Introduction  1
A History of Case Management   2
Language in Social Services   2
Why We Use Case Management   3
Case Management as a Process   4
Advocacy  13

Service Coordination  13
Levels of Case Management   16
Separating Case Management from Therapy   19
Case Management in Provider Agencies   19
Managed Care and Case Management   21
Caseloads  25
Generic Case Management   26
Summary  26
Exercises I: Case Management   27
Exercises II: Decide on the Best Course of Action   30
Chapter 2Ethics and Other Professional Responsibilities
for Human Service Workers   33
Introduction  33
The Broader Ethical Concept   34
Dual Relationships  35
Boundaries  40
Value Conflicts  40
The Rights of Individuals Receiving Services   44
Confidentiality  47
Privacy  51
Health Insurance Portability and Accountability Act   52
Social Networking  55
Privileged Communication  56
When You Can Give Information   56
Diagnostic Labeling  59

ivContents

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Involuntary Commitment  60
Ethical Responsibilities  61
Protecting a Person’s Self-Esteem   62
Stealing from Clients   64
Competence  65
Responsibility to Your Colleagues and the Profession   65
Professional Responsibility  67
Summary  68
Exercises I: Ethics   69
Exercises II: Ethically, What Went Wrong?   71
Exercises III: Decide on the Best Course of Action   76
Exercises IV: What is Wrong Here?   76
Chapter 3Applying the Ecological Model: A Theoretical Foundation
for Human Services   77
Introduction  77
The Three Levels of the Ecological Model   79
The Micro Level: Looking at What the Person Brings   80
Looking at What the Context Brings   80
Why Context Is Important   81
Seeking a Balanced View of the Client   82
Developmental Transitions  86
Developing the Interventions   87
Working with the Generalist Approach   88
Macro Level Interventions Are Advocacy   88
Summary  90
Exercises I: Looking at Florence’s Problem on Three Levels   90
Exercises II: Designing Three Levels of Intervention   91

Section 2 Useful Clarifications and Attitudes
Chapter 4
Cultural Competence   95
Introduction  95
Culture and Communication   95
Your Ethical Responsibility   96
Where Are the Differences?   96
Strangers  98
Anxiety and Uncertainty   99
Thoughtless versus Thoughtful Communication   100
Dimensions of Culture   104
Obstacles to Understanding   109
Competence  111
Summary  112
Exercises I: Testing Your Cultural Competence   113
Chapter 5
Attitudes and Boundaries   117
Introduction  117
Understanding Attitudes  117
Basic Helping Attitudes  118

Contents
v

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Reality Check  123
How Clients Are Discouraged   124

A Further Understanding of Boundaries   127
Seeing Yourself and the Client as Completely Separate Individuals   127
Erecting Detrimental Boundaries   129
Transference and Countertransference   129
Summary  130
Exercises I: Demonstrating Warmth, Genuineness, and Empathy   131
Exercises II: Recognizing the Difference—Encouragement
or Discouragement  136
Exercises III: Blurred Boundaries   136
Chapter 6
Clarifying Who Owns the Problem   139
Introduction  139
Boundaries and Power   140
If the Client Owns the Problem   141
If You Own the Problem   143
If You Both Own the Problem   144
Summary  145
Exercises I: Who Owns the Problem?   145
Exercises II: Making the Strategic Decision   147

Section 3 Effective Communication
Chapter 7
Identifying Good Responses and Poor Responses   149
Introduction  149
Communication Is a Process   150
Twelve Roadblocks to Communication   151
Useful Responses  156
Summary  164
Exercises: Identifying Roadblocks   165
Chapter 8

Listening and Responding   169
Introduction  169
Defining Reflective Listening   170
Responding to Feelings   170
Responding to Content   174
Positive Reasons for Reflective Listening   176
Points to Remember   177
Summary  178
Exercises I: How Many Feelings Can You Name?   179
Exercises II: Finding the Right Feeling   179
Exercises III: Reflective Listening   180
Chapter 9
Asking Questions   187
Introduction  187
When Questions Are Important   187
Closed Questions  188
Open Questions  189

viContents

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Questions That Make the Other Person Feel
Uncomfortable  190
A Formula for Asking Open Questions   192
Summary  195
Exercises I: What Is Wrong with These Questions?   195
Exercises II: Which Question Is Better?   197

Exercises III: Opening Closed Questions   198
Exercises IV: Try Asking Questions   200
Chapter 10 Bringing Up Difficult Issues   203
Introduction  203
Confrontation  203
Exchanging Views  204
When to Initiate an Exchange of Views   204
Using I-Messages to Initiate an Exchange of Views   207
Asking Permission to Share Ideas   213
Advocacy: Confronting Collaterals   214
On Not Becoming Overbearing   215
Follow-up  217
Summary  217
Exercises I: What Is Wrong Here?   217
Exercise II: Constructing a Better Response   219
Exercises III: Expressing Your Concern   219
Exercises IV: Expressing a Stronger Message   222
Chapter 11 Addressing and Disarming Anger   225
Introduction  225
Common Reasons for Anger   225
Why Disarming Anger Is Important   226
Avoiding the Number-One Mistake   227
Erroneous Expectations for Perfect Communication:
Another Reality Check   228
The Four-Step Process   229
What You Do Not Want to Do   231
Look for Useful Information   233
Safety in the Workplace   233
The Importance of Staff Behavior   234
Summary  235

Exercises I: Initial Responses to Anger   235
Exercises II: Practicing Disarming   236
Chapter 12 Collaborating with People for Change   239
Introduction  239
What Is Change?   239
Stages of Change   240
Understanding Ambivalence and Resistance   244
Encouragement  247
Recovery Tools  250
Communication Skills That Facilitate Change   252

Contents
vii

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Trapping the Client   258
From Adversarial to Collaborative   258
Summary  262
Exercises: Helping People Change   263
Chapter 13 Case Management Principles: Optional Review   265
Introduction  265
Combining Skills and Attitudes   265
Practice  267
Exercise I  267
Exercise II  268
Exercise III  271
Exercise IV  273

Exercise V  274

Section 4Meeting Clients and Assessing
Their Strengths and Needs
Chapter 14 Documenting Initial Inquiries   277
Introduction  277
Walk-ins  278
Guidelines for Filling Out Forms   278
Steps for Filling Out the New Referral
or Inquiry Form   278
Evaluating the Client’s Motivation
and Mood  282
Steps for Preparing the Verification of Appointment Form   282
Summary  284
Exercises I: Intake of a Middle-Aged Adult   284
Exercises II: Intake of a Child   284
Exercises III: Intake of an Infirm, Older Person   285
Chapter 15 The First Interview   287
Introduction  287
Your Role  288
The Client’s Understanding   288
Preparing for the First Interview   288
Your Office  290
Meeting the Client   290
Summary  295
Chapter 16 Social Histories and Assessment Forms   297
Introduction  297
What Is a Social History?   298
Layout of the Social History   298
How to Ask What You Need to Know   299

Who Took the Social History   306
Social Histories in Other Settings   310
Writing Brief Social Histories   311

viiiContents

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Using an Assessment Form   314
Taking Social Histories on a Computer   316
Taking Social Histories in the Home   316
The Next Step   317
Summary  317
Exercises I: Practice with Social Histories   318
Exercises II: Assessment of a Middle-Aged Adult   318
Exercises III: Assessment of a Child   319
Exercises IV: Assessment of an Infirm, Older Person   320
Exercises V: Creating a File   320
Chapter 17 Using the DSM  321
Introduction  321
Is DSM Only a Mental Health Tool?   322
Cautions  322
Who Makes the Diagnosis?   323
Background Information  323
The DSM-IV-TR  327
DSM 5, the Current Diagnostic Manual   328
Making the Code Using DSM 5  330
Multiple Diagnoses  331

Other Conditions That May Be a Focus
of Clinical Attention  332
When the Diagnosis Does Not Quite Fit   332
When There Is No Number   333
Summary  333
Exercises: Using the DSM 5   334
Chapter 18 The Mental Status Examination   337
Introduction  337
Observing the Client   338
Mental Status Examination Outline   339
Summary  356
Exercises: Using the MSE Vocabulary   356
Chapter 19 Receiving and Releasing Information   359
Introduction  359
Sending for Information   359
If You Release Information   359
Directions for Using Release Forms   360
Examples of the Release Forms   362
When the Client Wants You to Release Information   363
When the Material Is Received   363
Other Issues Related to Releasing Information   365
Summary  365
Exercises I: Send for Information Related to a
Middle-Aged Adult  366
Exercises II: Send for Information Related to a Child   366
Exercises III: Send for Information Related to a Frail,
Older Person  366
Exercises IV: Maintaining Your Charts   366

Contents

ix

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Section 5 Developing a Plan with the Client
Chapter 20 Developing a Service Plan at the Case Management Unit   367
Introduction  367
Involving the Client and the Family   368
Using the Assessment  369
Creating the Treatment or Service Plan   372
How to Identify the Client’s Strengths   373
Individualized Planning  374
Understanding Barriers  375
Sample Goal Plan   375
Summary  376
Exercises: Broad General Goal Planning   377
Exercise I: Planning for a Middle-Aged Adult   377
Exercise II: Planning for a Child   377
Exercise III: Planning for an Infirm, Older Person   377
Exercise IV: Maintaining Your Charts   377
Exercise V: Checking Services   378
Chapter 21Preparing for a Service Planning Conference or
Disposition Planning Meeting   379
Introduction  379
What You Will Need to Bring to the Meeting   380
Goals for the Meeting   380
Benefits of Conference Planning   381
Collaboration  382

Preparing to Present Your Case   383
Making the Presentation   383
Sample Presentation  384
Follow-Up to Meeting   385
Summary  385
Exercises: Planning  386
Exercise I: Developing a Service Directory   386
Exercise II: A Simulated Planning Meeting   386
Chapter 22 Making the Referral and Assembling the Record   387
Introduction  387
Determining Dates  388
Sample Referral Notification Form   389
The Face Sheet   390
Summary  392
Exercises: Assembling the Record   393
Chapter 23 Documentation and Recording   395
Introduction  395
The Importance of Documentation   396
Writing Contact Notes   396
Labeling the Contact   398
Documenting Service Monitoring   398
Documentation: Best Practice   399
Government Requirements  402
Do Not Be Judgmental   402

xContents

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Distinguish Between Facts and Impressions   403
Give a Balanced Picture of the Person   404
Provide Evidence of Agreement   404
Making Changes to the Plan   404
Summary  404
Exercises: Recording Your Meeting with the Client   405
Exercise I: Recording Client Contacts   405
Exercise II: Using Government Guidelines to Correct Errors   411
Exercise III: Spotting Recording Errors   411

Section 6 Monitoring Services and Following the Client
Chapter 24 Monitoring the Services or Treatment   413
Introduction  413
What Is Monitoring?   414
The Financial Purpose of Monitoring   414
Follow-Up  416
Collaboration with Other Agencies   416
Advocating  417
Leave the Office   418
Responding to a Crisis   419
Summary  420
Chapter 25Developing Goals and Objectives at
the Provider Agency   421
Introduction  421
Client Participation/Collaboration  422
Make Objectives Manageable   423
Expect Positive Outcomes   423
Objectives  425
Combining Goals and Treatment Objectives   426

Finishing Touches  428
Review Dates  429
Vocabulary  430
Summary  432
Exercises: Developing Goals and Objectives   432
Exercise I  432
Exercise II  433
Exercise III  434
Exercise IV  436
Exercise V  437
Chapter 26 Terminating the Case   439
Introduction  439
A Successful Termination  440
The Discharge Summary   443
Examples  444
Summary  447
Exercises I: Termination of a Middle-Aged Adult   448
Exercises II: Termination of a Child   448
Exercises III: Termination of a Frail, Older Person   448
Exercises IV: Organizing the Record   448

Contents
xi

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Appendix A Ten Fundamental Components of Recovery   449
Appendix B Vocabulary of Emotions   451

Appendix C Wildwood Case Management Unit Forms   454
Appendix DProchaska and DiClemente’s Stages of Change Model   487
Appendix E Work Samples   490
Appendix F Grading the Final Files   496
Appendix GInformation for Understanding DSM IV TR Diagnoses  499
Appendix HCase Manager’s Toolbox   506
References  515
Index  518

xiiContents

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Preface

In a small nonprofit agency handling cases of domestic violence, a woman answers the
phone. She assesses the caller’s concerns, accurately notes the caller’s ambivalence on
the inquiry record, and readily connects the caller to the person most able to assist.
In a mental health case management unit a new worker listens with interest to
the other case managers, the psychologist, and the psychiatrist discuss the possible
diagnosis for a new client of the agency. The worker is able to understand the conversation as the group talks about the DSM IV TR diagnosis and the new DSM 5 diagnosis.
Down the street a young man acting as a case manager in a substance abuse
detox center handles intake calls from physicians’ offices. He competently notes the
main concerns for incoming patients and asks the questions he knows will give him
information that doctors and therapists will need later as they work with these new
admissions. His notes are clear and useful.
How long did it take these people to acquire these skills? Did they acquire this
ability well after being hired in a social service agency, or did they arrive able to handle

case management tasks competently?

Purpose
For me and for students, the issue has been how we can teach the social services skills
that will promote their walking from the classroom into the social service setting with
confidence. How can we be assured that students, often steeped in sound theoretical
knowledge, will be able to fill out an inquiry form or make a referral effectively?
It is important to teach these practical skills. In addition, it is important to equip
students with the vocabulary and methods used by more advanced professionals in the
human service field so that upon entering the field students are prepared to engage in
meaningful discussions around client issues. Although entry-level individuals would
not usually give a DSM diagnosis, it is useful for individuals entering the field to be
knowledgeable about what such a diagnosis is and what is meant by an Axis I or Axis II
diagnosis or how diagnoses are given using DSM 5. In this way, conversations among
professionals will not be misunderstood.
Today individuals with a sparse education or with recent college degrees are finding themselves thrust immediately into roles for which they have had little formal
training. It is crucial, therefore, to find a method for teaching the actual human service
experience at the entry level. Fundamentals of Case Management Practice: Skills for the
Human Services, fifth edition, seeks to provide that experience in a thorough, step-bystep process that leads the reader from intake through monitoring to termination.

Preface
xiii

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New in the Fifth Edition
New material has been added to this fifth edition to bring the textbook up to date.
Added to this edition:

•
•
•
•

•
•
•
•
•
•
•
•
•
•
•
•

Current terms are used throughout
Information on the DSM 5 and how entry level individuals can use this
Recent changes to HIPAA
Expanded Appendices to include material helpful in completing exercises in the
text, a safety planning tool and a case manager’s tool box with information to
assist in assessment and disposition.
A clear look at case management as a process
A discussion of how the size of a caseload affects service
Ethical considerations for those working in the field of substance abuse
A discussion of the differences among moral, ethical, and legal behavior and how
violations are addressed
More information on the importance of mandated reporting

Expanded treatment of the ecological model
Broader section on empathy and more recent findings on empathy
An extensive feelings list in the appendix for use in various exercises
Differences between confrontation and an exchange of points of view
Enhanced discussion of motivational interviewing and why this is useful
More detail on the significance of the first interview
There are fewer chapters as some material has been combined in single chapters

In addition, a considerable number of smaller items and changes specifically requested by our reviewers were added to the textbook.
Fundamentals for Practice with High Risk Populations (Summers, 2002) has been
published as an adjunct to this text, giving students information and scenarios on
­populations in which they are interested or with whom they intend to work. Chapters
cover topics such as case management with children and their families, survivors of
rape and violence, older people, issues with drug and alcohol dependence, and mental illness and developmental disabilities. Each chapter features information about
­specific populations and provides exercises and intake forms. This textbook also contains a set of forms that can be copied (see Appendix C). These forms can be found
on CengageBrain. Taken from actual social service settings, they give the reader an
opportunity to practice accuracy and skill in handling social service forms and records
and in organizing information.
If you do not wish to cover all of the populations discussed in the text on high-risk
populations and instead want to focus on specific populations, you can order individual
chapters from Fundamentals for Practice with High Risk Populations (Summers, 2002). Please
visit to view chapters online and to build your custom text.
You can pick chapters about specific populations and create individualized booklets that
you can bundle with this text. If you would like more information about custom options,
please contact your local customer service representative. You can locate your representative by using our rep finder at />
xivPreface

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

Format
For each chapter in the textbook, basic information is laid out, followed in most chapters by many exercises that prompt the reader to handle real issues and practice real
skills. Each of the chapters on case management describes one of the case management responsibilities followed by exercises to practice applying the information. As
readers progress through the text, they gradually assemble files on specific cases. Students can create and monitor believable fictional clients using one of the high-risk
populations discussed in Fundamentals for Practice with High Risk Populations (Summers, 2002). Classroom discussions about these cases and the best disposition for each
of them are not unlike the discussions that occur every day in a variety of social service settings.

Organization of the Textbook
The organization of the textbook follows a logical progression, beginning with the
most basic foundation for good practice, moving to discussions on attitudes, followed
by how the student will talk to others effectively. The second half of the book follows a similar process, beginning with the person’s first contact with the agency and
the assessment and planning process through all the case management procedures to
termination.
In Part One, “Foundations for Best Practice in Case Management,” readers are
introduced to important foundation pieces for this field. A definition of case management and how it is central to social services, ethics and ethical issues, and the importance of the ecological model in assessment and planning give readers an introduction
to professional basics.
In Part Two, “Useful Clarifications and Attitudes,” readers are invited to examine what in their thinking will impede effective helping in the social service setting.
Beginning with issues of cultural diversity and moving to the role of personal attitudes
and boundaries, this part concludes with information and exercises related to determining who owns the problem. Each chapter in this part contains exercises encouraging readers to examine realistically their own attitudes and judgments.
Part Three, “Effective Communication,” begins by introducing the reader to
good and poor responses, with exercises that help students see the c­ onsequences
of poor communication. Chapters on listening and responding, asking questions,
bringing up difficult issues, responding to emotions, confronting problematic
­
­behavior, and disarming anger are included. Included is a chapter that gives an
­expanded examination of some of the techniques and ideas related to motivational
interviewing. The section ends with a chapter on the effective application of what
students have just learned and exercises designed to have students practice all the
communication skills in order to smooth out the communication and allow it to b

­ ecome
natural and responsive.
In Part Four, “Meeting Clients and Assessing Their Strengths and Needs,”
readers begin to take inquiries for services. Forms are provided that ask for basic

Preface
xv

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.


information, teaching the student what is important to find out in that first call. This
section also includes a chapter on preparing for the first interview, helping the reader
become sensitive to issues that clients might have at a first meeting. A chapter on
social histories and assessment forms teaches students how to use these to assemble
relevant information. Introductions to the DSM and to the mental status examination
allow the reader to become familiar with the vocabulary and the information most
important to other professionals in the human service field. Students are encouraged
to begin noting how a person seems to them at the time of contact. The chapters and
classroom discussions will help students pin down what is important to note. In this
section, readers also practice completing release of information forms for the clients
they have developed in the classroom setting, mastering which records are useful and
which are not.
Part Five, “Developing a Plan with the Client,” allows readers to further develop
a plan for those clients for whom they have created phone inquiries. Here, individually
or in planning teams, according to the instructor’s process, students develop realistic
plans for their clients. A chapter is included instructing students on how to prepare for
and participate in team planning. In the final chapters, students refer cases to providers of services and learn about documentation and recording.
Part Six, “Monitoring Services and Following the Client,” is the final section,

and the section begins with a chapter on monitoring services and treatment. Students
switch to the role of a worker in the agency of a provider of service and take the general goals given them by case managers and develop specific goals and objectives to be
accomplished within stipulated time lines. Here students learn how to develop attainable goals for their clients. In this part, readers also learn the importance of monitoring
cases from a case management perspective and how to terminate the case. Numerous
documentation exercises provide opportunities for students to begin writing professional notes and keeping good records.

Supplements Accompanying This Text
Cengage Learning Testing, powered by Cognero Cognero is a flexible, online system that allows you to author, edit, and manage test bank content as well as create
multiple test versions in an instant. You can deliver tests from your school’s learning
management system, your classroom, or wherever you want.
Online Instructor’s Manual The instructor’s manual contains a variety of resources
to aid instructors in preparing and presenting text material in a manner that meets
their personal preferences and course needs. It presents chapter-by-chapter suggestions and resources to enhance and facilitate learning.
Online PowerPoint® These vibrant Microsoft PowerPoint® lecture slides for each
chapter assist you with your lecture by providing concept coverage using images, figures, and tables directly from the textbook.

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MindTap MindTap for Counseling engages and empowers students to produce
their best work—consistently. By seamlessly integrating course material with videos,
­activities, apps, and much more, MindTap creates a unique learning path that fosters
increased comprehension and efficiency.
For students:
• MindTap delivers real-world relevance with activities and assignments that
help students build critical thinking and analytic skills that will transfer to other
courses and their professional lives.

• MindTap helps students stay organized and efficient with a single destination
that reflects what’s important to the instructor, along with the tools students
need to master the content.
• MindTap empowers and motivates students with information that shows where
they stand at all times—both individually and compared to the highest performers
in class.
Additionally, for instructors, MindTap allows you to:
• Control what content students see and when they see it with a learning path that
can be used as-is or matched to your syllabus exactly.
• Create a unique learning path of relevant readings and multimedia activities that
move students up the learning taxonomy from basic knowledge and comprehension to analysis, application, and critical thinking.
• Integrate your own content into the MindTap Reader using your own documents
or pulling from sources like RSS feeds, YouTube videos, websites, GoogleDocs,
and more.
• Use powerful analytics and reports that provide a snapshot of class progress, time
in course, engagement, and completion.
In addition to the benefits of the platform, MindTap for Counseling offers:
• Video clips tied to the learning outcomes and content of specific chapters.
• Activities to introduce and engage students with each chapter’s key concepts.
• Interactive exercises and in-platform discussion questions to provide direct,
hands-on experiences for students of various learning styles.
• Review and reflection activities to demonstrate growth and a mastering of skills
as students progress through the course.
Helping Professions Learning Center Designed to help you bridge the gap between coursework and practice, the Helping Professions Learning Center offers a
centralized online resource that allows you to build your skills and gain even more
confidence and familiarity with the principles that govern the life of the helping professional. The interactive site consists of five learning components: video activities
organized by curriculum area and accompanied by critical thinking questions; ethics,
diversity, and theory-based case studies; flashcards and practice quizzes; a professional
development center; and a research and writing center.

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To the Students
It is always a challenge to know what skills and information you will need on the first
day of your first job. Even when you are already working in the field and managing
many of the tasks well, you often do not know for certain why agencies choose to do
things one way as opposed to another. This textbook seeks to empower you to function competently and to know why you are proceeding or should be proceeding with
clients in a particular way.
In Fundamentals of Case Management Practice, you will follow a specific series of
steps, beginning with what you are thinking and how to incorporate ethics into your
thinking in client–worker relationships, continuing through your communication with
clients, and ending with your putting together hypothetical case files and managing
those hypothetical cases.
Throughout the course you will find yourself in discussions with others about
possible treatment or service plans or the dynamics of a person’s situation. Use these
discussions to learn more about collaboration and to increase your ability to participate
in the same sort of discussions in the agency where you will work.
Many students have taken this textbook to work with them and have found it
both useful and realistic. Students have contributed their experiences on the job to
make this textbook replicate as nearly as possible the issues and concerns you will
encounter in your work with other people.
Further, in developing your hypothetical clients, you may want to refer to Fundamentals for Practice with High Risk Populations (Summers, 2002). In that textbook, six
populations commonly served by social services, such as those associated with domestic
violence, substance abuse, or mental health issues, are detailed so that you will be very
familiar with their issues and likely problems. It is also possible to purchase individual

chapters from that textbook on the population or populations that interest you. Each
chapter will give you information on common problems, diagnoses, medications, treatments, and other considerations such as legal issues or common medical problems each
specific population often experiences. See the instructions on how to order specific
chapters in the earlier section of this Preface titled “New in the Fifth Edition.”

To the Instructor: Suggestions for
Using This Text
This text can be used to take students step-by-step through the case management
process outside of the often harried and pressured atmosphere of a real social service
agency. When the student is ultimately confronted with the actual situation, the routine and expectations will not be new. Chapters are broken down into each step in the
case management process. Readers progress according to their skill levels, finally creating cases and caseloads with you acting as the supervisor, much as a supervisor would
act in an actual agency. Without the urgency, you will have time to let students look up

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information, discuss possible diagnoses, and develop sound interventions under your
guidance. For example, exercises on the DSM and on the mental status examination
have a number of possible answers. Your discussion with your students, similar to the
discussions that take place in agencies about these possibilities, is more important
than the actual answers that are chosen.
Most chapters include exercises to help students practice their skills. Often
several versions of the same exercise are provided. It is useful to students to begin
in small groups to address the issues posed in the exercises. Their discussions and
the ideas and concerns they bring back to the larger class are consistent with discussions held in social service agencies. Later, versions of the exercises can be used as
tests, or you can go back to them at a later time to make sure students continue to
practice their skills.

It is extremely worthwhile for students to apply the skills described in this book
to specific populations. To do this, you can use this book in conjunction with my other
book, Fundamentals for Practice with High Risk Populations (Summers, 2002). After students have read the chapters on the specific populations you have assigned or on those
that are most interesting to them, they can create a fictional “typical” client that they
can then walk through all the exercises from intake to termination. Case notes would
reflect the common problems encountered by the population, and intake would describe a common reason for seeking services among people in this population. This
gives students a good beginning look at how cases come in and unfold while clients
are receiving services.
Details on six high-risk populations are provided in Fundamentals for Practice
with High Risk Populations (Summers, 2002). A detailed chapter on children and their
families gives students information on how to include others involved in the child’s
life and how to coordinate all the various entities with whom the family interacts.
Another chapter focuses on domestic violence and rape, including how these issues
affect children.
A third chapter looks at substance abuse and includes the common social and
medical issues that arise for this population. This chapter also includes the common challenges this population presents to case managers and gives tips for how to
handle these. Mental health and intellectual disabilities each are featured in chapters, giving common problems and issues, diagnoses, and treatments. Finally, there
is a chapter focusing on aging that includes both medical and social issues for this
population. All the chapters include an assessment form for that population taken
from actual agencies that work with that population, and all the chapters give the
most typical diagnoses and medications used with each population. Where a population has special considerations the student should know, these are included as well.
For example, in the chapter dealing with issues most likely to affect women, there
is a discussion of how women’s programs and agencies differ in their approach to clients from other social service agencies. To order specific chapters related to specific
populations, see instructions in the earlier section of this Preface titled “New in the
Fifth Edition.”

Preface
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Benefits and Advantages
This material has been used in my own classroom for 30 years and has been updated
to meet current social service trends and changes. Students have commented that
using this text is like walking from the classroom into the social service setting with
very little lost time in learning the actual process. Instructors teaching the practicum
course have used the word empowered when describing what this text has done to give
students confidence and skill in their first encounter with a social service position.
Employers as well often contact me to say how well prepared students are who have
used this textbook.
Three positive features of this textbook make it especially useful in preparing
students to work in this field:
1. The text gives very basic information a person needs to handle each of the tasks
described. Theoretical information can be found in many other places, and thus
the concentration and focus are on what is important to note, think about, document, and pass on in each step of the human service process.
2. Numerous exercises create very real situations for students to consider and handle. These exercises are based on real experiences taken from my 23 years of
practice in human services and from the experiences of many others who graciously contributed to this book. Doing the exercises and participating in the
classroom discussions that follow will expose students to an extremely broad
range of possible circumstances and difficulties in the field.
3. The book contains forms that give students an opportunity to practice compiling information at various times throughout the management of the case. These
forms can be copied and used to create files on clients developed by the students. Using each form a number of times gives students practice in preparation
for real clients in real social service settings.
These features, when taken together, create a nearly realistic social service setting in
the classroom, giving the instructor many opportunities to strengthen student skills
and sensitivity.
In addition, Fundamentals for Practice with High Risk Populations (Summers, 2002)
supports students with applicable details and considerable information on various atrisk populations. This textbook acts as a reference so that the hypothetical clients
students develop are real with entirely likely problems. Students can use the material

found in this supplemental textbook to develop realistic clients, create useful service
plans, and make appropriate referrals.

Acknowledgments
As with each edition of this textbook, I could not write such a realistic work ­without
the wonderful help of the staff at the Dauphin County Case Management Unit.
­Always ready to give their time and support, they have answered important questions,
clarified new national policies, and brought enthusiasm to the writing of this book.

xxPreface

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I particularly want to acknowledge the help of Mathew Kopechny, former Executive
Director who went out of his way to see that I had access to what I needed to make this
textbook current. I am grateful for the time and useful examples provided by Michelle
Beahm, who allowed me to shadow her for the preparation for this edition. In addition,
I want to express my gratitude to Kim Castle, clerical supervisor, who has worked with
me on each edition of this book to clarify issues and give me details I might otherwise
have missed. Just knowing she was there to help made writing this book much easier.
Thanks go as well to Joel Smith, intake case manager, who graciously allowed me to
observe an intake with a client during my time observing at the Dauphin County Case
Management Unit.
I am particularly indebted to Charles Curie, MA, ACSW who has always
given time to discuss issues related to the textbook. He headed the Pennsylvania
Office of Mental Health and Substance Abuse Services, making Pennsylvania a
leader in innovative services and procedures. Appointed by President Bush to
head the Substance Abuse and Mental Health Services Administration (SAMHSA)

he instituted state-of-the art prevention and treatment ideas nationally. His support of
this textbook has ensured the teaching of best practices.
At the Dauphin County Executive Commission on Drugs, Alcohol and
­Tobacco, I want to thank John Sponeybarger for his help in formulating realistic
plans and ­services. I am grateful to the late Ruby Porr for her ideas based on her
work as a service provider and to Aimee Bollinger Smith, Karen Polite, Wendy
­Bratina, and Carol R
­ einertsen who use this textbook and had teaching suggestions
for additions to the text.
I deeply appreciate the support and information my husband, Martin Yespy, contributed to this work. His unfailing assistance and encouragement of these textbooks
and the useful material and information he brought from the field of crisis intervention
have enhanced this work.
I especially want to thank my editor, Julie Martinez, who has given me support,
guidance, and a good dose of humor when needed. She has always been there when
I needed help and her advice greatly enhanced this work.
The two students, Danica Zirkle and Keyanna Watkins, who organized and then
participated in the videos deserve considerable gratitude for all the work they did to
keep everyone on track. The students who participated in the vignettes, w
­ riting and
­rehearsing their work also deserve my gratitude for all their hard work. They are
­Catherine ­Wrighstone, Tom Moulfair, Sean Taney, Michele Anthony, and Alison ­Kilgore.
Many thanks to Michelle Beahm again for participating in the videos and ­giving her
ideas to make the vignettes more realistic. Brian Peterson and his crew from Motion
Masters provided considerable direction and made the filming smooth and effortless.
My thanks to all of them for the time they spent with us.

Preface
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I would also like to thank the reviewers of this textbook for their very helpful
comments:
Susan M. Scully-Hill,
Assumption College
Barry Yvonne,
John Tyler Community College
Paula Gelber Dromi,
California State University, Los Angeles
Alyssa Forcehimes,
University of New Mexico
Monte Gray,
Bronx Community College
Karen Guerrieri,
Kent State University, Salem
Richard Jenks,
Tillamook Bay Community College
Lee Ann Rawlins,
University of Tennessee
Their ideas and suggestions greatly strengthened this work.

xxiiPreface

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C

h

a p

t

e

r

1

Case Management: Definition
and Responsibilities

Introduction
Case management is one of the primary places in human service systems where the
whole person is taken into account. Unlike specific services, case management does
not focus on just one problem but rather on the many strengths, needs, and personal
concerns a person brings.
For example, an elderly person may be referred to Help Ministries for a voucher
for fuel oil because it has been unusually cold and the elderly person has been unable
to pay for the additional oil needed to warm his home adequately. In this case, Help
Ministries is concerned with his fuel oil need and the warmth he will need to stay in
his home during the winter. That is their only concern with regard to this man.
The case manager, on the other hand, is concerned with the person’s need for
fuel oil, with his desire to move into public housing for the elderly in the spring, with
what resources he has among his children, with his recent slurred speech indicating
a possible stroke, and with his need for meals-on-wheels. The case manager is aware

that there is a neighbor who can look in on him daily, that the man has ties to a church,
and that he receives Social Security but little other income. She knows he has a sense
of humor, goes to bingo once a month, and should be fitted for a cane.
Case management is a process for assessing the individual’s total situation and
addressing the needs and problems found in that assessment. As a part of this process, the person’s strengths and interests are used to improve the overall situation
wherever possible. The primary purpose for case management is to improve the quality of life for your client. This might mean more comfortable or safer living arrangements, or it might require psychiatric care or medication for diabetes. Another major
purpose of this activity is to prevent problems from growing worse and costing more to



Chapter 1   Case Management: Definition and Responsibilities

1

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